|Home | About | Journals | Submit | Contact Us | Français|
Report by Daniel Mercier, Emergency Medicine Resident
Search checked by Jeff Jones, Emergency Medicine Attending
Grand Rapids Medical Education & Research/Michigan State University
A short cut review was carried out to establish whether serum lactate might be a marker for mortality in patients presenting to the emergency department with an infection. Only one paper was found addressing the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. The clinical bottom line is that serum lactate may be a marker for mortality in patient admitted with an infection‐related diagnosis.
In [a patient presenting to the emergency department with infection] is [serum lactate] a [predictor of mortality]?
A 40‐year‐old male presents to the emergency department with a 4 day history of cellulitis of the lower extremity, fever and chills. How useful is an initial serum lactate concentration drawn in the emergency department as a predictor of mortality?
Medline 1950–2007 April Week 1 using the OVID interface. Cochrane Database of Systematic Reviews and Cochrane Central register of Controlled Trials, April 2007 [(lactic acid.mp. or exp Lactic Acid/) OR (lactate.mp.) OR (exp Acidosis, Lactic/)] AND [(exp Infection/or infection.mp.) OR (sepsis.mp. or exp Sepsis/) OR (septic shock.mp. or exp Shock, Septic/OR severe sepsis.mp.)] AND [(emergency medical services.mp. or exp Emergency Medical Services/) OR (exp Emergency Service, Hospital/or emergency department.mp.)]
A total of 18 papers were found on Medline, of which only one directly addressed the question (table 11).). No additional papers were found in the Cochrane Library.
An initial serum lactate may be useful in risk stratification in patients presenting to the emergency department with infections. Conversely, it may be a covariate of another clinical marker. There appears to be an increasing trend of mortality with elevated initial lactate levels. 22.4% patients with an initial lactate level >4.0 mmol/L died within 3 days.
Initial serum lactate levels drawn in the emergency department may serve as an overall marker of mortality in patients admitted to the hospital with an infection‐related diagnosis.